To the editor,
With the creation of the American Health Care Act, the federal state Medicaid programs face some of the most substantial changes that they have faced since its implementation in 1965. HR 1628, as currently adapted, replaces the current federal matching program with a per capita cap on federal dollars which is intended to limit the growth of these funds to the rate of growth of the medical component of the consumer price index with and additional 1 percent for Americans over 65 and individuals with disabilities.
The Congressional Budget Office predicts that this solution will result in federal funding being reduced by $800 billion over the next decade. This type of reduction has the potential to be an unprecedented financial risk to individual states. In a situation that has become increasingly polarized, legislators, advocates and policy-makers should refocus on the basic questions of how can we improve the value of Medicaid spending without diminishing quality? And where can we find common ground to achieve these ends?
One opportunity for bipartisanship is the flexibility of states in regards to Medicaid. States often use Social Security Act 1115 waivers to utilize options that are not in accordance with Federal Medicaid Regulations. (Minnesota is actually in the process of applying for one now to exempt our chemical dependency facilities from the IMD rule.) The Affordable Care Act increased regulatory requirements for requests for waivers and for their renewal, which substantially increased the administrative burdens on the states.
Giving states more flexibility in addressing challenges with the Medicaid program coincides with the basic Republican platform stances of limited government and states’ rights.
The Democrats are unlikely to support initiatives such as requiring employment in exchange for eligibility. They will be more likely to support concepts such as alternative payment methods. Flexibility that allows for experimentation with new approaches to Medicaid payments is an opportunity for bipartisanship and is beneficial to both taxpayers and patients.
An increased need for the program and for revisions will in the near future be bringing a variety of policy proposals to the table, which to be legitimately beneficial will need to provide for an honest assessment of the weaknesses of the program and create policies that address that realistic assessment and the reality of the demographic it serves.